Musculoskeletal Diagnoses

Question 1

Achilles Tendon Rupture

Answer 1

• Typically occurs within one to two inches above teh tendinous insertion on the calcaneous
• incidence is greatest between 30-50 years of age without history of calf or heelpain
• patient with an Achilles tendon rupture will typically be unable to stand on their toes and tend to exhibit a positive THompson test

Question 2

adhesive Capsulitis

Answer 2

• Occurs more in teh middle-aged population with females having a greater incidence than males
• arthrogram can assist with diagnoses by detecting decr volume of fluid within the joint capsule
• ROM restriction typically in a capsular pattern

Question 3

ankle SPrain Grade II

Answer 3

• typically occurs due to significant inversion and involves the lateral ligament complex, most commonly damages the anterior talofibular ligament
• Will likely present with significant pain or tenderness along the lateral aspect of the ankle especiallly at the ATFL
• should heal fairly quickly if no other structures are involved and will return to the previous functional level within two to six weeks

Question 4

Anterior Cruciate Ligament Sprain- Grade III

Answer 4

• Injury most commonly occurs during hyperflexion or landing in an unbalanced position
• Females involved in selected athletic activities have significantly higher ligament injury rates compared to males
• approx 2/3 of complete anterior cruciate ligament tears have an associated meniscal tear

Question 5

Bicipital Tendonitis

Answer 5

• incr incidence of injury is associated with selected athletic activities such as baseball pitching, swimming, rowing, gymnastics and tennis
• characterized by subjective reports of a deep acche directly in front and on top of the shoulder made it worse with overhead activities such as lifting
• examination may reveal a positive SPeed’s test or Yergason’s test

Question 6

Lateral epicondylitis

Answer 6

• characterized by inflammation or degenerative changes at the common extensor tendon that attaches to the lateral epicondyle of the elbow
• repeated overuse of teh rist extensors, particularly the extensor carpi radialis brevis, can produce tensile stress and result in microscopic tearing and damage to the exetnsor tendon
• clinical symp include difficulty holding or gripping objects and inssuffient foream functional strength

Question 7

Medial Collateral Ligament SPrain- Grade II

Answer 7

• Grade II injury is characterized by partial tearing of the ligament’s fibers resulting in joint laxity when the ligament is stretched
• mechanism of injury is usually a blow to the outside of the knee joint causing excess force to the medial side of the joint
• Return to previous functional level should occur within four to eight weeks following the injury if no other associated structures are involved

Question 8

Osteoarthritis

Answer 8

• Degenerative process primarily involving articular cartilage resulting from excessive loading of a healthy joint or normal loading of an abnormal joint
• typically diagnosed based on the results of a clinical examination and x-ray findings

-prevalence is higher among women than men later in life with approx 80-90% of individuals older than 65 years of age demonstrating evidence of osteoarthritis

Question 9

Osteogenesis Imperfecta

Answer 9

• classified into four types with a wide range of clinical presentations ranging from normal appearance with mild symptoms to severe involvement that can be fatal during infancy
• Bonde densitometry may be used to measure bone mass and estimate the risk of fracture for specific sites within the body
• children with osteogenesis imperfecta often have delayed developmental milestones secondary to ongoing fractures with immobilization, hypermobility of joints, and poorly developed muscles

Question 10

Patellofemoral Syndrome

Answer 10

• Causes damage to the articular cartilage of the patella ranging from softening to complete cartilage destruction resulting in exposure of subchrondral bone
• etiology is unknown, however, it is extremely common during adolescence is more prevalent in females than males and has a direct association with activity level
• management includes controlling edema stretching strengthening improving ROM and activity modification

Question 11

Plantar fasciitis

Answer 11

• Chronic overuse condition that develops secondary to repetitive stretching of the plantar fascia through excessive foot pronation during the loading phase of gait
• characterized by severe pain in the heel when first standing up in the morning
• intervention consists of ice massage, deep friction massage, heel insert, orthotic prescription, activity modification, and gentle stretching program of teh Achilles tendon and plantar fascia

Question 12

Rotator Cuff tear

Answer 12

• May occur as a result of an acute traumatic incident or due to a chronic degenerative pathology such a chronic supraspinatus
• teh drop arm test and empty can test can assist in identifying supraspinatus pathology which may be indicative of a rotator cuff tear
• Failure to adequately treat a rotator cuff tear may necessitate significant activity modifications, additional surgical management, adhesive capsulitis or degenerative changes

Question 13

Rotator Cuff tendonitis

Answer 13

• Caused by an inability of a weak supraspinatus muscle to adequately depress the head of the humerus in the glenoid fossa during elevation of the arm
• participating in activities that require excessive overhead activity such as swimming, tennis, baseball, painting and other manual labor activities incr the risk of rotator cuff tendonitis
• Patients may experience a feeling of weakness and identify the presence of a painful arc of motion most commonly occuring between 60 and 120 degrees of active abduction

Question 14

Scoliosis

Answer 14

• curvature is usually found in the thoracic or lumbar vertebrae and can be associated with kyphosis or lordosis
• patient with scoliosis that ranges 25-40 degrees require a spinal orthosis and physical therapy intervention for posture, flexibility, strengthening, respiratory function, and proper utilization of the spinal orthosis
• Scoliosis does not usually progress significantly once bone growth is complete if the curvature remains below 40 degrees at the time of skeletal maturity

Question 15

Spondylolidthesis- degenerative

Answer 15

Caused by the weakening of joints that allows for forward slippage of one vertebral segment on the one below due to degenerative changes

• most common site of degenerative spondylolisthesis is the L4-L5 level
• William’s flexion exercises may be indicated to strengthen the abdominals and reduce lumbar lordosis

Question 16

Temporomandibular joint Dysfunction

Answer 16

• Females are at greater risk than males with the most common age ranging from 20-40 years of age
• clinical presentation includes pain , muscle spasm, abnormal or limited jaw motion, HA, and tinnitus
• intervention includes patient education, posture retraining and modalities such as moist heat, ice, biofeedback, US, electrostimulation, TENS, and massage

Question 17

Torticollis- COngenital

Answer 17

• Causes the neck to involuntarily contract to one side secondary to contraction of the SCM
• head is laterally flexed toward the contracted muscle, the chin faces the opposite direction, and there may be facial asymmetries
• Studies indicate that between 85-90% of pt with congenital torticollis respond to condervative tx and passive stretching within teh first year of life

Question 18

Total Hip Arthroplasty

Answer 18

• Pt are typically over 55 years of age and have experienced consistent pain that is not relieved through conservative measures which serve to limit the patient’s functional mobility
• posterolateral approach allows the abductor muscles to remain intact, however, there may be a higher incidence of post-operative joint instability due to the interruption of the posterior capsule
• Cemented hip replacement usually allows for partial WB initially, while a noncemented hip replacement requires toe touch WB for up to six weeks

Question 19

Total knee Arthroplasty

Answer 19

• Primary indication for TKA is teh destruction of articular cartilage secondary to osteoarthritis
• post-operative care may include a knee immobilizer, elevation of the limb, cryotherapy, intermittent ROM using continuous passive motion machine, and initiation of knee protocol exercises
• Patient eductaion may include items such as avoid excessive stress to the knee, squatting, quick pivoting, using pillows under the knee while in bed, and low seating

Question 20

Total shoulder arthroplasty

Answer 20

• Surgical candidates have irreparable damage, deterioration, and destruction to the humeral head and the glenoid fossa within the shoulder complex
• Surgical complictaions include mechanical loosening of the prosthesis instability, rotator cuff tear, implant failure, heterotopic ossification and intraopertaive fracture
• Life expectancy is longer for the shoulder compared to the knee or hip since the shouler is a non-WB joint

Question 21

Transfemoral Amputation due to Osteosarcoma

Answer 21

• a highly malignant cancer that begins in the medullary cavity of a bone and leads to the formation of a mass
• A patient status post trasfemoral amputation may present with fatigue, LOB, phantom pain or sensation, hypersensitivity of the residual limb, and psychological issues regarding the loss of teh limb
• Lying in a prone position is beneficial to decr the incidence of a hip flexion contracture

Question 22

Transtibial amputation due to arteriosclerosis Obliterans

Answer 22

• arteriosclerosis obliterans results in ischemia and subsequent ulceration of teh affected tissues
• pt status post transtibial amputation may have a decr in cardiovascular status depending on the freq of intermittent claudication experienced prior to the amputation
• Preprosthetic intervention should focus on strength, ROM, functional mobility, use of AD, desensitization, and patient education for care of the residual limb

Question 23

Disk herniation

Answer 23

• Often the result of gradual, age-related changes that cause disk degeneration
• Risk factors include being overweight and having an occupation that requires repetitive lifting, bending or twisting
• Physical therapy may consist of education on activity modification and appropriate body mechanics, soft tissue manipulation, lumbar stabilization exercises, traction, and modalities for pain relief

Question 24

Glenohumeral Dislocation- Anterior

Answer 24

• Mechanism of injury may vary but typically involves a forceful external blow or loading force when the shoulder is in a position that combines abduction, lateral rotation and extension
• Prior to relocation of teh joint, visible deformity, severe pain, and significant ROM limitations are teh most significant characteristics
• is not life-threatening through recurrent dislocations can have a substantial impact on a patient’s lifestyle

Question 25

Medial epicondylitis

Answer 25

• Occurs with repetitive wrist or elbow motions or gripping, and is often seen in golfers or those who play throwing or racket sports
• Initial treatment consists of rest, ice, anti-inflammatory medications, massage, stretching, and bracing to helpcontrol acute symptoms
• Home care regimen consists of stretching and strengthening exercises, especially for the wrist flexor and forearm pronator muscle groups, as well as icing to help control symptoms

Question 26

Meniscal tear

Answer 26

• Often involve twisting of teh knee when in a semiflexed position with the foot planted on the ground
• characterized by joint line pain and tenderness, swelling, loss of ROM, a complaint of “catching” or “locking” within the joint, and feelings of instability
• Physical therapy focuses on teh interventions to reduce swelling, normalize ROM, and improve muscular strength

Question 27

Osgood-Schlatter Disease

Answer 27

• Refers to traction apophysitis occurring at the tibial tuberosity where symptoms are typically exacerbated by running, jumping, and squatting activities
• characterized by localized pain and edema with point tenderness over the patella tendon’s insertion on the tibial tuberosity
• limiting symptoms may last for weeks or months before abating, however, the condition typically will resolve in time without intervention

Question 28

Piriformis syndrome

Answer 28

• characterized as the result of compression or irritation to the proximal sciatic nerve due to piriformis muscle inflammation, spasm or contrcature
• loctaion of pain is often imprecise, though typically presents first in teh area of teh mid-buttock the progresses to radicular complaints in teh sciatic nerve distribution
• Patient typically respond well to physical therapy interventions and are able to return to regular activities without restriction

Question 29

posterior cruciate ligament sprain

Answer 29

• occurs when a posteriorly directed force is applied to the tibia in relation to the femur, such as when the knee hits the dashboard in a motor vehicle accident
• individuals participating in contact activities requiring a high level of agility are particularly susceptible to a posterior cruciate ligament injury
• a large majority of patients that experience a posterior cruciate ligament sprain are able to return to their previous level of function, including participation in athletics

Question 30

Spinal Stenosis- Lumbar

Answer 30

• Refers to a narrowing of either the lumbar vertebral or intervertebral foramen with symptoms resulting from mechanical compression on either the spinal cord or existing nerve roots
• symptoms include a gradual onset and worsening of chronic pain at the midline of the lumbar region, unilateral nerve root radiculopathy, paresthesia, weakness, and diminished reflexes
• Severity of symptoms reported varies widely and directly influences expectations for long-term outcomes of physical therapy interventions

Question 31

Trochanteric Bursitis

Answer 31

• May occur as a result of acute or cumlative trauma to the lateral hip causing irritation to the trochanteric bursa
• Causative factors may include a true or functional leg length discrepancy, history of lateral hip surgery, and participation in sports with significant running or contact
• Pt typically respond well to conservative interventions and should be able to return fully to their prior level of function including sport activity

Question 32

Anterior Compartment Syndrome

Answer 32

• Characterized by incr pressure in the lower leg secondary to swelling, which can occlude blood flow and cause ischemia and necrosis of the surrounding nerves and musculature
• chronic cases may occur secondary to athletic exertion; acute cases are often caused by a traumatic injury and are considered a medical emergency
• Symptoms include tightness and tenderness over the muscle belly of the tibialis anterior, pain with passive stretching or active use of the muscle, and paresthesias and/or numbness in the distribution of the deep peroneal nerve

Question 33

Colles’ Fracture

Answer 33

• FRequently occurs when an individual reaches forward with their hands while attempting to break a fall; characterized by a transverse fracture of the distal radius
• Trauma related to this maneuver is commonly termed a FOOSH “fall on outstretched hand” injury
• X-ray of the wrist is the preferred method of confirming a Colles’ fracture and identifying displaced fragments or damage to adjacent bony structures

Question 34

De Quervain’s Tenosynovitis

Answer 34

• -Results from an inflammatory process involving the tendons and synovium of the abductor pollicis longus and extensor pollicis brevis at the base of the thumb
• Onset is typically due to repetitive activities involving thumb abduction and extension such as racquet sports and repeated heavy lifting
• symptoms onset may be gradual or sudden depending on the mechanism of injury with report of localized pain and tenderness in the area of the anatomical snuffbox which may radiate

Question 35

Myositis Ossificans

Answer 35

• characterized by the calcification of muscle that is usually caused by neglecting to properly treat a muscle strain or confusion
• Development of this condition occurs within a few weeks after the initial injury and may include a noticeable hard lump in the muscle belly, an increase in pain, and a decrease in ROM
• an x-ray is the primary imaging study used to confirm the diagnosis

Question 36

Osteomyelitis

Answer 36

• an infection that occurs within the bone, most commonly secondary to the staphylococcus aureus microbe
• damage to the bone from a surgical procedure, compound fracture or puncture wound that penetrates the bone may directly expose the bone to infectious microbes
• a bone biopsy is the most conclusive procedure fro diagnosing osteomyelitis and determining that specific infectious microbe present

Question 37

tarsal tunnel syndrome

Answer 37

• occurs as a result of compression of the tibial nerve as it passes through the tarsal tunnel, causing neuropathy in the distribution of the nerve
• Signs and symptoms include pain, numbness and paresthesias in the foot, muscle atrophy and weakness, diminished light touch and temperature sensation and an antalgic gait pattern
• Tinel’s sign can be used to confirm the presence of teh condition, though diagnostic test may also be performed

Question 38

Ulnar Collateral Ligament sprain - Thumb

Answer 38

• Occurs secondary to a traumatic event in which an excessive valgus force is applied to the metacarpophalangeal joint of the thumb
• the therapist should perform ligament stability testing of the thumb by applying a valgus force to the joint, with a movement of greater than 30-35 degrees indicating a complete tear of the ulnar collateral ligament
• X-ray should be ordered to rule of the existence of a fracture or dislocation